摘要
目的分析髌旁外侧入路与髌上入路两种不同入路髓内钉内固定对胫骨干骨折患者骨折愈合、膝关节功能及并发症的影响。方法回顾性选取2022年1月至2024年11月空军军医大学第一附属医院骨科接受髓内钉内固定治疗的197例胫骨干骨折患者为研究对象。根据手术入路不同分为A组(102例)和B组(95例),A组行髌旁外侧入路髓内钉内固定治疗,B组行髌上入路髓内钉内固定治疗。比较两组患者临床疗效、手术相关指标、骨折愈合情况(骨折愈合时间、骨痂形成时间)、骨折端成角畸形情况(冠状面内翻、外翻畸形,矢状面前凸、后凸畸形)、膝关节功能[美国特种外科医院(HSS)膝关节功能评分]以及并发症发生情况。结果随访6个月时,A组优良率为96.08%(98/102),高于B组的87.37%(83/95),差异有统计学意义(P<0.05)。A组术中X线照射次数少于B组(P<0.05)。两组骨折愈合时间、骨痂形成时间、随访6个月内骨折端成角畸形发生率及术后并发症总发生率比较,差异无统计学意义(P>0.05)。随访3个月时,两组患者HSS膝关节功能评分比较,差异无统计学意义(P>0.05);随访6个月时,两组患者HSS膝关节功能评分均较随访3个月时升高,且A组高于B组,差异均有统计学意义(P<0.05)。结论相较于髌上入路,髌旁外侧入路髓内钉内固定治疗胫骨干骨折疗效更佳,能减少术中X线照射次数,促进膝关节功能恢复,但仍需注意术中力线的把控并减少对髌股关节的影响。
Objective To analyze the effects of two different approaches for intramedullary nailing—the lateral parapatellar approach and the suprapatellar approach—on fracture healing,knee joint function,and complications in patients with tibial shaft fractures.Methods A retrospective analysis was conducted on 197 patients with tibial shaft fractures who underwent intramedullary nailing in the Department of Orthopedics,The First Affiliated Hospital of Air Force Medical University from January 2022 to November 2024.According to the surgical approach,patients were divided into Group A(lateral parapatellar approach,n=102)and Group B(suprapatellar approach,n=95).The following were compared between the two groups:clinical efficacy,surgical-related indicators,fracture healing status(fracture healing time,callus formation time),angulation deformity at the fracture site(coronal varus/valgus deformity,sagittal anterior/posterior angulation),knee joint function[Hospital for Special Surgery(HSS)knee score],and complications.Results At the 6-month follow-up,the excellent-good rate in Group A was 96.08%(98/102),significantly higher than 87.37%(83/95)in Group B(P<0.05).Group A had fewer intraoperative X-ray exposures than Group B(P<0.05).No significant differences were found in fracture healing time,callus formation time,incidence of fracture angulation deformity within 6 months,or total postoperative complication rate(P>0.05).At the 3-month follow-up,no significant difference existed in HSS scores between groups(P>0.05).At the 6-month follow-up,HSS scores increased in both groups compared to the 3-month assessment,with Group A scoring higher than Group B(P<0.05).Conclusion Compared with the suprapatellar approach,the lateral parapatellar approach for intramedullary nailing offers superior efficacy in treating tibial shaft fractures,reduces intraoperative X-ray exposures,and promotes knee function recovery.Nevertheless,attention should be paid to intraoperative mechanical axis control and minimizing impact on the patellofemoral joint.
作者
罗鸣
李岩
党海峰
赵轶男
樊俊俊
常宇坤
高子龙
高武才
卢利利
韩莉
LUO Ming;LI Yan;DANGN Haifeng;ZHAO Yinan;FAN Junjun;CHANG Yukun;GAO Zilong;GAO Wucai;LU Lili;HAN Li(Department of Orthopedics,The First Affiliated Hospital of Air Force Medical University,Xi'an,Shaanxi 710032,China)
出处
《转化医学杂志》
2025年第8期42-46,共5页
Translational Medicine Journal
基金
陕西省重点研发计划项目(2021SF-178)。
关键词
胫骨骨折
骨折固定术
髓内
髌旁外侧入路
髌上入路
骨折愈合
tibial fractures
fracture fixation,intramedullary
lateral parapatellar approach
suprapatellar approach
fracture healing
